Hello, during a total knee replacement today, a huge clump of hair was discovered in the bottom of a tray of trials. I immediately called the tray contaminated, along with the entire back table. An argument ensued and I was told that the hair went through the sterilizer therefore it is sterile. I was always told that you could not sterilize hair via heat sterilization because it is a protein. Maybe nuts, but I wanted to be safe and do what was best for the patient. Unfortunately, the patient was already on the table...had to tear down and wait for the instruments to be redone. In the room at 7:28 and started at 11:01!! What is your opinion.

Basically, if it doesn't come with sterilization parameters, sterilization can't be confirmed. We've torn down tables because we've found coins in our trays, plastic disposable pieces left on various insertion instruments, etc. However, we do have all carriers open before the patient enters the room- the scrub person may have a pile of things to arrange, but we know that all instruments are good to go. This keeps us from having patients asleep in a room for extended lengths of time. All of that extra anesthesia time isn't risk free either. With a delay that long, the argument could have been made to cancel the patient's surgery, wake them up and go to PACU. For my heart patients, we've had to do that when a true life or death emergency (massive chest trauma/aortic dissection) happens at a point between induction and incision (anesthesia places central lines/swans after patient asleep, so bit of a delay here). I've never had a patient in a room asleep waiting for instruments. However, in a case like that we would flash sterilize as the tray is not implants and not be delayed as long, plus as a major ortho center, we have multiple trays of trials. Was another tray not available, even if "borrowing" from another case that wasn't started?

Wild Rose, you did the right thing to declare that the tray was contaminated, the unfortunate thing was having the patient on the table for just a long period of time.

Basically if it doesn't come with sterilization parameters, sterilization can't be confirmed. We've torn down tables because we've found coins in our trays, plastic disposable pieces left on various insertion instruments, etc. However, we do have all carriers open before the patient enters the room- the scrub person may have a pile of things to arrange, but we know that all instruments are good to go. This keeps us from having patients asleep in a room for extended lengths of time. All of that extra anesthesia time isn't risk free either. With a delay that long, the argument could have been made to cancel the patient's surgery, wake them up and go to PACU. For my heart patients, we've had to do that when a true life or death emergency (massive chest trauma/aortic dissection) happens at a point between induction and incision (anesthesia places central lines/swans after patient asleep, so bit of a delay here). I've never had a patient in a room asleep waiting for instruments. However, in a case like that we would flash sterilize as the tray is not implants and not be delayed as long, plus as a major ortho center, we have multiple trays of trials. Was another tray not available, even if "borrowing" from another case that wasn't started?[/quote']

They were specialty trays brought in specially for this procedure. So we didn't have back up. We have a very strict policy about flash sterilization. We almost never flash sterilize. The patient had had a spinal. Anesthesia kept them sedated. The whole situation was BAD. It started as a unicompartmental (which is the tray we found the hair in), and turned into a total. The trays were open, but the hair was on the second row of trials and was found as the scrub was setting up. To make matters worse, the surgery turned into a total knee, and when those trays were opened, the indicators were missing. So those trays had to come off the field and we were able to get another set, but of course that also delayed the case because they had to be retrieved from SPD, which is pretty far from the OR. WHAT A MESS!!! I can't seem to find anything regarding hair found in the tray and whether it can be sterilized. I just can't believe they told us it "should be fine". That's not good enough!!

How did trays without indicators make it to the field anyway? If there is no indicator, it should NEVER be out on the field. At my facility, if that happens, the whole set up is contaminated.

How did trays without indicators make it to the field anyway? If there is no indicator, it should NEVER be out on the field. At my facility, if that happens, the whole set up is contaminated.

I second this question. Our rule is that the indicator must be verified as passing before the tray is placed on the table. Sounds like your facility could benefit from some educational reinforcement on verification of sterility. Those responsible for sterilizing trays are human; they make mistakes such as forgetting to add an indicator prior to sterilization. The more checks and balances, the better.

Our indicators are put on the outside so that as soon as the nurses opened the tray it can be verified before the scrub even picks it up. We also have a rule where we open all trays before bringing the patient in the room as opening 10+ instrument trays can be very loud and confusing for the patient (especially if they are just under spinal).

You did the right thing. We would have broken the table down too. Who was it that argued that it was OK?

Hair can most certainly would not be considered sterilized because it is biological material and would need to undergo a different sterilization process than surgical instruments. You did the right thing by breaking the table down although you seem to feel guilty about delaying start time and prolonging anesthesia exposure. In the end you will have saved this patient from surgical site infection, removal of hardware, extensive repair and rehabilitation and the massive amounts of time and money lost and spent on recovery. Stick to your gut and know that you stood up for your patient!!

Our indicators are put on the outside so that as soon as the nurses opened the tray it can be verified before the scrub even picks it up. We also have a rule where we open all trays before bringing the patient in the room as opening 10+ instrument trays can be very loud and confusing for the patient (especially if they are just under spinal).

What do you mean by "outside"? Do you mean that the indicator is on top of the first tray? With trials, oftentimes the trays are multi-tiered. The scrub has to verify that EVERY indicator in EVERY level of the tray is good.

Our surgeons are intolerant of ANY delays getting into the room [most of them have 2 rooms]. Therefore, we are very often opening trays as the pt is coming into the room. However bad the noise and activity are for the patient, we still check each wrapper for holes, each "casket" for moisture, and everything for indicators. If there is any question about sterility, we flash it. Patients can be sedated so they don't remember anything, but we do not compromise sterility-ever!

You did the right thing!!!! When there is doubt, throw it out. First thing i learned about sterility over 30 years ago and it still stands true today.